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MI - Miller
| Term | Definition |
|---|---|
| Brief Action Planning (BAP) | a 5-tsep MI consistent process designed to be completed within a few minutes (used in medical settings) |
| BAP begins by asking this... | "Is there anything you'd like to do for your health in the next week or two?" |
| BAP - if person responds "yes" to initial questions, what happens next? | the BAP roadmap is followed - consisting of 4 further steps along lines of MI - developing plan, confidence ruler, accountability partner |
| Indicators someone is ready for change? (moving from "why" to "how") | hear more change talk (less sustain talk), envisioning, questions about change, talk of taking steps toward change |
| What is the essence of a "key question" | "What's next?" Examples: "What do you think you'll do?" "What might be the next step?" |
| Rather than asking clients if they are ready to make a change, instead we ask this... | Use confidence scales to gauge how important a change is and how confident they are they can do it. |
| In this stage, the fixing reflex may kick back in, posing danger to losing client's self-motivation in the process. | Planning stage, exploring the "how" of change |
| In the planning stage, you are evoking .... | the "how" of change |
| A good way to start negotiating a change plan is to ask the person... | what they have tried so far |
| When brainstorming goals and identifying options or steps toward change, where should ideas come from? | Client - Practitioner can add to list (with permission), then ask "Which of these sound like a good place to start" |
| True or False - A change plan might involve settling on a first step to take. | True, particularly when the magnitude of change seems daunting to the client |
| Mobilizing change talk includes terms such as... | willing, consider, possibly, might, or try |
| True or False. The same evoking methods used to bring our reasons to change can be used to strengthen a person's confidence. | True |
| Confidence talk terms... | could, can, able to, possible |
| True or False. Confidence ruler can also be used to gauge confidence. | True, then use follow up questions (ex. "How might I help you go from a ___ to a [higher number]?" |
| What is "Characteristics of Successful Changers"? | An approach used in affirming strengths - a list of 100 positive adjectives, have client circle a few that describe them (at least 5), then interview them about these strengths w/open ended ques. |
| Reviewing Past Successes is another source to | build confidence by exploring how people have navigated change in the past (ex. "What changes have you made in your life that were difficult for you?") |
| What is a "reframing strategy"? | used to reinterpret "failure" in a way that encourages rather than blocks further change attempts (ex. reframing failure as persistence, strong intention) |
| Respond to confidence talk using this method... | OARS - Open ended questions, Affirming strengths, Reflecting self-confidence stmts, Summarizing their own reasons for optimism about change |
| True or False. During later stages of confidence talk, it is appropriate to raise possible challenges that could be encountered, and ask client or solutions? | True - (ex. "What might you do if....?" or "How could you respond if...?" |
| Finding hope involves .... | calling forth what is already there |
| What is "envisioning"? | hearing when client imagines aloud what a change would be like (even if it's the challenges) |
| Decisional balance | when one side of the balance is weighted by arguments favoring the status quo; the other side contains weights faoring the change - one indicator of person's readiness to change (pro/con balance) |
| Change talk | anything people say that tends to move them toward taking a particular action |
| Preparatory Change Talk | hear when people are considering whether to do something. 4 types reflect person's (DARN) Desire, Ability, Reasons, or Need for the change |
| Desire language (type of Preparatory Change Talk) | a way of saying "I want" (ex. want, wish, like, love, would enjoy) |
| Ability language (type of Preparatory Change Talk) | provides information about how confident people are that they would be able to take action (ex. can, could, able, possible) |
| Reason language (type of Preparatory Change Talk) | has an if-then quality- might be possible advantage of change or disadvantage of not changing (ex. "If I think I would sleep better at night if I cut down on caffeine." |
| Need language (type of Preparatory Change Talk) | has imperative quality emphasizing some urgency of change (ex. "I have to" "I need to" "I really must" "I've got to" |
| Mobilizing Change Talk | tends to get people moving (3 types)-(CAT) commitment, activation, taking steps |
| Commitment language (type of Mobilizing Change Talk) | offers assurance it will happen |
| Activation language | hear people leaning toward actions (ex. "I'm willing to." "I would consider it." "I'm thinking about it.") - signals openness but not quite a decision to do something |
| Taking-Steps Language | a form of speech indicating that the person has already taken some action in the direction of change (ex. "I filled that prescription yesterday," I called three places about possible jobs today." |
| Sustain Talk (aka counterchange talk) | Language supporting the status quo (no change) |
| Ambivalence | an inner debate between the arguments for and against change |
| How many types of change talk and what is the acronym? | 7; DARN CATs |
| Sustain Talk or change talk? "I need to be able to smoke." | Sustain |
| Sustain Talk or change talk? "I bought some nicotine gum today." | Change talk |
| Sustain talk or change talk? "My children are begging me to quit." | Change talk |
| Sustain talk or change talk? "I don't think I could stand the withdrawal." | Sustain talk |
| TRUE or FALSE Ambivalence is often demonstrated by both change talk and sustain talk being intertwined in same sentence? | TRUE (ex. "I'd like to go out with you, although I really need to stay home and study for a test." or "I wish I could quit smoking, but I don't think I can." |
| The evoking of change talk involves these 3 key skills: | 1. attending 2. inviting 3. strengthening (pay attention to language of change so when hear it recognize it, instead of waiting for it, invite the person to offer more of it, when hear change talk, respond to it in ways to strengthen it) |
| Change talk reveals | a person's own motivations for change |
| Things you can do to invite change talk | ask Directional questions, MI Consistency, Exploring extremes, Looking back or forward, Exploring Goals or Values |
| Directional questions | open ended questions |
| Importance ruler | scale "On a scale from o to 10, where 0 is not important at all, how important would you say it is for you to make this change?" |
| Follow up to importance ruler question- | Once you hear a number, (ex. 4), then you ask, "And why a 4 rather than a 0?" (the answer is likely to be change talk) - do not ask why 4 and not 8 or 10? that would be sustain talk. |
| confidence ruler ques ex | "On a scale from 0 to 10, how confident are you that you could do this if you decide to?" (this evokes confidence or ability language.) |
| Do NOT ask these questions that trigger sustain talk... | "Why haven't you changed?" "What keeps you from doing this?" What do you like about the way things are now?" "Why can't you just do it?" |
| True or False - Affirmations can both increase change talk and diminish sustain talk. | True |
| Exploring extremes | What are the "best" possible benefits you can imagine? |
| Looking Back or Forward | Ask person to look back to time before current troubles to tell you what life was like then. Can alternatively ask people to look forward and imagine a future time after have successfully made the changes they seek. |
| Exploring Goals or Values | No one is unmotivated. What is most important to "this" person? (ex. evoke top five values - then ask whether alcohol helps them achieve it) |
| Process of change talk (3 steps) | 1. listen for (attend to), recognize, remember change talk 2. invite change talk rather than waiting for it. 3. when hearing it, respond in a way that strengthens it and invites more. |
| Strengthening Change Talk - respond with ... | OARS - 1. open ended questions 2. Affirming 3. Reflecting 4. Pull the change talk into summaries |
| Directional Reflections | differentially mirrors particular content - in case of evoking, change talk. If you reflect change talk you hear it. |
| Change talk for "See, all my friends drink. Some probably way too much, but if I quit drinking i won't have any friends." Reflection response... | "At the same time, you recognize that you and probably some of your friends drink way too much." |
| Lending Change Talk | reflecting change talk clients have not yet spoken (ex. a person describes a lot of difficulties with relationship. You say "You're really ready for some change in this relationship" |
| What tells you if you are on right track with lending change talk? | The person's response |
| Directional Summaries | periodic summaries of what has been said to review progress so far, make sure you have a common understanding or to draw things together as you transition from one topic to another or at the end of a session. |
| Responding to Change Talke | When you hear it, use your OARS - ask open questions (o) that invite elaboration or examples. Affirm change talk (a). Offer reflective listening stmts (r), and pull change talk together in summaries (s). |
| What about insincere change talk? | 1. express concern (doubts) in empathetic way. Then follow with reflective listening. |
| Guidelines for ethical use of MI (4) | 1. Beneficence (person's wellbeing/best interests) 2. Autnomy 3. Honesty 4. Conflict of Interest |
| Focusing means... | clarifying what changes the person might make. |
| Straightforward goal (type of focusing) | clear at the outset |
| Choosing a path (type of focusing) | overall goal is apparent but it's less clear how best to pursue it. |
| Clarifying (type of focusing) | No defined goal or options to choose from; whateverhopes the person may have for change are vague (ex. when they respond that "everything" is wrong.) |
| Which type of focusing may require longer listening? | Clarifying |
| Clarifying usually starts with a ______ goal or concern and moves toward more ______. | broad; specificity |
| Bubble Sheet | tool used to lay out the possibilities visually. Could draw and fill in topic bubbles together or use prepared sheet with common options. |
| Empathy | an ability to understand and feel with what others are experiencing |
| Listening well has both ____ and ____ components | inner; outer |
| The inner component of listening is an... | attitude of curiosity (leading you to wonder what this person is thinking/feeling) |
| The outer behavioral component is the mirroring skill of .... | reflective listening |
| Accurate Empathy | a method for voicing and testing your guesses about what the person you are talking to is trying to convey. (become mirror, reflect back to person what they are experiencing to best of your understanding) |
| mirroring involves | letting go of other ways of responding (ex. your own opinions, advice, agreeing/disagreeing) - these are roadblocks |
| Reflection | statement |
| Simple Reflection | stays fairly close to what person said but doesn't have to be parroting; might focus on a part of what was said (not adding much to what person said) |
| Complex Reflection | makes a bit of a guess about what the person means. Usually, it's not a big leap but rather a possible extension of what the person said. |
| Simple or complex reflection? Speaker: I'm feeling kind of down today. L: "You're feeling low." | Simple reflection |
| Simple or complex reflection? S: I'm feeling kind of down today. L: "Like you don't have much energy." | complex reflection (a guess) |
| Simple or complex reflection? S: It's like I'm dragging a lot of weight behind me. L: "Like carrying a burden." | Simple reflection |
| Simple or complex reflection? S: I'm thinking about something Emma said last night. L: "It's bothering you." | Complex reflection |
| In reflecting there is ___ penalty for missing. | no ; learn more either way |
| Affirmation | |
| Continuing the paragraph means... | offering what might be the next sentence (seomthing the person might say next but hasn't said yet) |
| overstate | a reflection that adds intensity to the content or emotion that was expressed |
| understate | a reflection that diminishes or understates the intensity of the content or emotion expressed by a client |
| Double-sided reflection | includes both sides of the dilemma (ex. You enjoy being able to drive yourself around but don't want to injure anyone.) *helpful with ambivalence |
| Analogy | saying something that seems to be "like" what the person is saying |
| Shared decision making | Actively engages clients in choices regarding their own lives; whereby people are offered the best evidence about options and are supported to choose how to proceed |
| Value-behavior discrepancies | Conflicts between a person's actions and their core goals or standards that provide meaning and direction in life. |
| Self-affirmation | Statements that recognize a person's own positive efforts or attributes. |
| Neutrality | An interviewer's intentional decision not to influence the direction of choice or change. |
| Agenda Mapping | Selecting from a menu of possibilities the topic(s) to be discussed in a consultation. |
| Cultivating change talk | Responding in a manner that increases the depth, strength, or momentum of a person's language in favor of change. |
| Embedded change talk | Change talk that is expressed in combination with sustain talk. |
| Experiencing | Speaking about oneself in first-person, present-tense, emotionally engaged language. |
| Vertical Ambivalence | The simultaneous presence of competing motivations for and against change, with the person consciously aware of one motivation but unaware of an opposing motive. |
| Ask-offer-ask (AOA) Approach | An information exchange process that begins and ends with exploring the person's own experience to frame whatever information is being provided. |
| Developing Ambivalence | Cultivating perceived discrepancy between the status quo and a client's important goals and values. |
| Norm Correction | An intervention offering information on what is actually average behavior based on reliable survey or other normative data. |
| Self-Regulation | The ability to develop a plan of one's own and to implement behavior in order to carry it out. |
| Amplified Reflection | |
| Apology | |
| Coming Alongside | |
| Pendulum Approach | |
| Psychological Reactance | |
| Shifting Attention | |
| Softening Sustain Talk | |
| Beginner's Mind | |
| Seeking Collaboration | |
| Deliberate Practice | |
| Learning Community | |
| TNT - Training of New Trainers (in MI) | |
| Computer-Automated Coding | |
| Confront Response | |
| Evidence-based Treatment (EBT) | |
| Fidelity Drift | |
| Implementation Science | |
| Interrate Reliability | |
| MI Process Code (MIPC) | |
| MI Skills Code (MISC) | |
| MI Supervision and Training Scale (MITI) | |
| Persuasion Response | |
| Quality Assurance | |
| Real Play | |
| Role Play |
Created by:
hdemerly